Arguably, the best changes are ones that are subtle but make a big impact. To that end I would like to welcome our readers to ADVANCE for Physical Therapy and Rehab Medicine, a new and improved version of the national physical therapy newsmagazine that serves your profession.

We're expanding our focus in ADVANCE to include more coverage of practice management, sports medicine, modalities, equipment on the market and many other topics of special interest to all those involved in the physical therapy and rehabilitation medicine professions.

We aim to better bring together all the aspects of the practice of physical therapy and rehab medicine to one solid resource for PTs, PTAs, ATCs, rehab managers and other professionals involved in the field.

Keep an eye out for our special sections on doing business and succeeding at rehab management, news on new therapy products and inventions, and frequent Buyers' Guides to help you quickly shop for the tools you need to keep your PT practice or clinical setting up to date.

You'll still see all the news, departments and features that set us apart, from our PT Inventor features on therapists who use their abilities to create, to our In the Spotlight stories on therapists who are living unique lives and careers. And our website will continue to complement our print edition while also offering lots of exclusive content.

On Oct. 21, the Senate voted against a motion that would have brought S. 1776, the Medicare Physicians Fairness Act of 2009, to the floor for debate. According to the Oct. 23 PT Bulletin from APTA, the motion failed by a vote of 47 to 53, which stopped further consideration of the bill.

The opposing votes included 13 Democrats, who were concerned that the $245 billion cost of the bill was not offset. The legislation, introduced last week by Sen. Debbie Stabenow (D-MI), would have eliminated the sustainable growth rate (SGR) and prevented a 21 percent reduction in Medicare payments to providers on January 1, 2010. Despite the failure of this legislation to pass, APTA will continue its efforts to work with Congress to find alternatives to the SGR formula. What is your reaction to these developments?

The Houston area's largest Medicare HMO--TexanPlus--put on the event, which drew 600 senior bowlers.  

The event served to encourage seniors to get stronger and fitter to help prevent falls. The Centers for Disease Control and Prevention state that falls are the leading cause of injury-relate death in seniors.

"I think it's very important for us as we get older to stay in sports and whatever we can do," the article quoted participant Sarah Pilgreen as saying.

Do you incorporate Wii into your treatment plans? Other than improving one's balance, what else can Wii be used for?

This month, AfterCollege.com researched the top metro areas across the country to for people looking for jobs in physical therapy. (See the full story here.)

They looked at entry-level jobs as well as jobs from orher media to find cities with the most employers, and they also included the Bureau of Labor Statistics for unemployment data for each area. The list of the top 10 cities and surrounding areas for entry-level physical therapists are:

1. Dallas/Fort Worth, TX

2. Baltimore, MD

3. Cleveland, OH

4. Chicago, IL

5. Phoenix, AZ

6. Newark, NJ

7. San Francisco/Bay Area

8. Atlanta, GA

9. Washington, DC Area

10. Boston, MA

The areas in the top 10 should not really surprise us, since many are major metro areas and have a plethora of job and recreation attractions nearby.

But certainly some areas are more productive for those looking to get into the profession than other areas. Some have scarce continuing education options, such as bridge programs. Others, in rural areas for example, lack the community structure that many look for in places to put down roots, such as a good school district, cultural attractions and an adequate transit system.

For PTs and PTAs out there who have moved to another state, major city or even another country to obtain a job, what else factored into your decision on where to live?

On Oct. 1, the APTA submitted a Statement for the Record to the Committee on Veteran Affairs, noted Volume 10, Issue 39 of PT Bulletin Online. This committee held a hearing on HR 1036, the Veterans Physical Therapy Services Improvement Act, introduced by Rep. Stephanie Herseth-Sandlin (D-SD). The bill will take the Physical Therapy Qualification Standards instituted in February by Veterans Affairs (VA) Secretary Eric K. Shinseki and make them law, as well as create a Director of Physical Therapy Services and fellowship programs for physical therapists within the VA in four specialized areas of practice (geriatrics, amputee rehabilitation, polytrauma and rehabilitation research).

"The need for high quality rehabilitation provided by physical therapists has never been greater with the dual challenges of caring for the chronic diseases faced by aging veterans and the multifaceted profile of many of today's wounded warriors," stated APTA.

What is your opinion about this proposed legislation?

Beth Israel Medical Center (BIMC) in New York City has been named the beneficiary of an initiative set in motion by world renowned designer, Donna Karan. When her husband, Stephan Weiss, lost his battle with cancer just over eight years ago, Karan was moved to take action.

"I am determined to do what I can to create a new model for wellness and patient care, and to address the needs of patients' loved ones and the staff who are on the journey with them," Karan shared.

Through her own foundation, Urban Zen Foundation, Karan has teamed up with the Department of Integrative Medicine and the Division of Medical Oncology at BIMC to create a unique pilot program that will enhance the care of hospitalized cancer patients. The vision includes:

• the introduction of yoga therapists on the floor to deliver bedside care
• a full-time staff member to help cancer patients access all levels of care
• training of nursing staff in holistic practices to encourage optimal healing
• an extensive research program, and
• physical renovations to Beth Israel's inpatient cancer unit

"Our goal is to treat the whole patient through techniques of eastern healing, yoga and meditation that is combined with the very best in western medicine," Karan expressed.

In your opinion, does alternative medicine have a place in hospitals and medical centers?

Specifically, the death rate among patients was 6 percent higher on this day than patients who were admitted the last Wednesday in July. From 2000 to 2008, scientists analyzed approximately 300,000 patients who were admitted to state-run hospitals across England on those two Wednesdays.

The researchers controlled for patients' age, sex, socioeconomic status and secondary medical problems, and found the odds of dying to be 6 percent higher for those admitted on the Wednesday in August. However, the odds among medical admissions (patients who were not suffering from cancer and did not require surgery) were 8 percent higher. The findings were published in PLoS ONE.

An article in Time that referenced the study reported, "An influx of new medical staff, in other words, just might be very, very bad for your health."

Do you agree?

Stephanie, a former resident at the Pediatric Center, led the crowd of more than 200 philanthropists, board members, patients and staff and administration in the Pledge of Allegiance.

Next the Pediatric Center's staff choir-led by one of the center's music therapists-performed rousing renditions of The Star-Spangled Banner and God Bless America during which tears of both joy and sorrow were visible as they remembered residents who were unable to be present.

Throughout the day, many referred to the center's mission of "changing lives, one child at a time," and explained that their work is based on "unconditional love." The love and devotion of each and every constituent, from CEO Patricia A. Tursi to the center's volunteers, was apparent.

Presently located in Manhattan, the pediatric and rehab center will continue to care for children with a wide range of medical conditions at its new location set to open in 2011 in Yonkers, NY.

Despite a grim forecast, it turned out to be a beautiful day but the beauty was clearly emanating from within. Sister Carol Anne Barnes, Chair of the Board of Trustees, gave thanks to "our beloved children for keeping the rain away."

Each year, Elizabeth Seton Pediatric Center's leadership develops a business plan to set goals in keeping with its mission. Events like the groundbreaking, staff talent shows, employee recognition awards and awards given by professional organizations all offer opportunities to celebrate the work of fulfilling this mission.

What is your facility's mission and what do you do as an organization to celebrate your accomplishments while setting new goals to strive for?

View our photo gallery here!

According to the APTA's Sept. 4 PT Bulletin Online (http://www.apta.org/AM/Template.cfm?Section=Current_Issue#article63798), the organization recently submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2010 Medicare physician fee schedule. APTA encouraged CMS to adopt its proposal to use the physician practice information survey data to calculate practice expense relative value units. In addition, APTA urged CMS to remove physician-administered drugs from the calculation of the sustainable growth rate. "Comments also were submitted on the proposed 2010 outpatient prospective payment system," the report continued. "APTA requested that CMS clarify that physical therapy, occupational therapy and speech-language pathology services do not require direct physician supervision in an outpatient hospital department. APTA urged CMS to recognize the role of physical therapists in the final national coverage determination for cardiac and pulmonary rehabilitation." What are your thoughts on these stances taken by the national association?

"Back in May, concerns about the flu were ebbing because flu season in the U.S. was nearing its end," CNN Polling Director Keating Holland told CNN. "But the flu didn't go away-it just moved to other places around the world. Now a new flu season is starting, and worries about H1N1 are back."

Most Americans have confidence that the government would be able to prevent a nationwide epidemic, according to a CNN/Opinion Research Corporation survey released this morning. And two-thirds of adult Americans would get a H1N1 flu shot if one became available.

Do you think people have a right to be worried? Or is the media creating unnecessary fear?

The therapists stressed the importance of knowing what their patients--who range in age from birth to 18--are interested in. Whether it's tuning in to the latest cartoon, knowing the latest in iPod technology, reading books in the Twilight series or knowing who Miley Cyrus is, the therapists know how infinitely easier therapy can be if they are able to make a little small talk or align an activity to suit the patient's interests.

When therapists are armed with current "kid knowledge," they can be more flexible in finding age-appropriate activities. As a result, the kids enjoy themselves and are more willing to participate in the task at hand. What strategies have you learned to help relate to the patients at your facility?

ADVANCE is already receiving some nice feedback about our Aug. 10, 2009, cover story on therapists who entered the profession later in life, many after following established careers in other fields for years.

The story, "Late Bloomers," tracked several therapists into their moves into the profession. The subjects found by freelance writer Lauren Fritsky had diverse careers, from manual labor to surgical technology. They expressed a desire to do something "more meaningful," as one newly minted PT put it, while still being able to "work with their hands."

One letter writer expresses a similar theme: "I had a 25-year career in the corporate world as an engineer, statistician and research scientist. However, after a layoff, I decided to pursue something I could feel more passionate about, and something that truly made a difference. Like the subjects of your article, I think the field of physical therapy offers tremendous opportunities for directly and positively impacting the lives of others. Already in my brief experience, I can say that I am reaping the rewards I was seeking."

As I have stated many times, a brief check of the U.S. Bureau of Labor statistics suggests that PT and the health care field in general is an OK place to be in a recession-even when it worsens. But the static numbers and promise of always being needed might not assuage some fears.

No doubt, the reeling economy of the past eight months has caused many to rethink their career options, either by force (if unfortunate enough to be laid off) or by contemplation about what a changing health care climate might mean to their futures. I wonder how many physical therapists and PT assistants are considering this.

Do you think more people will opt for the PT profession, or opt out? We don't hear about therapists leaving the profession much, so has the economy had the opposite effect? Surely many "new" therapists who adopted PT as their second life path would agree with the latter.

On a recent visit to Seattle Children's Hospital in Seattle, WA, I learned about some of the health care challenges faced by American Indians and Alaska Natives living in both urban and rural settings in the United States. Serving as the pediatric referral hospital for Washington, Alaska, Montana and Idaho, Seattle Children's has a unique perspective on providing care to a large area with diverse populations.

Millions of American Indians and Alaska Natives living in or near cities face significant heath care disparities but are seemingly invisible to health care providers and federal and state policy-makers, according to a report released by the Urban Indian Health Commission (UIHC) entitled Invisible Tribes: Urban Indians and Their Health in a Changing World.

Many of these citizens may see an end to funding from the Indian Health Service or may be ineligible for or unable to use the health services offered. And even when urban Indians do manage to access health care, they must overcome additional barriers such as cultural misunderstandings and communication obstacles.

To make heath care more accessible for the Alaska Native children and families it serves, Seattle Children's provides language and other assistance to patients coming from various tribes-each with their own dialect. What can your facility do on a local and national level to make access to health care easier for this sector of our country's population?

In order to be eligible for the ADVANCE Hall of Fame, an individual must have at least 20 years of service in the physical therapy profession. Nominations can be submitted by anyone-a co-worker, a friend, a loved one-you can even nominate yourself if so inclined!

To enter, please send your name, phone number and e-mail address-as well as the name, phone number and e-mail address of the person you're nominating-and the reasons why this person should be the first-ever ADVANCE for Physical Therapists and PTAs hall of Famer to managing editor Rob Senior via e-mail at RSenior@advanceweb.com or by regular mail at 3100 Horizon Drive, King of Prussia, PA 19406.

Nominations the contest must be received by November 2, 2009. Good luck!

According to a July 31 press release (http://www.apta.org/AM/Template.cfm?Section=Current_Issue#article62366) from APTA, the association will partner with the Canadian Physiotherapy Association and World Confederation for Physical Therapy to host the first annual International Summit on Direct Access and Advanced Scope of Practice in Physical Therapy, October 22-24 in National Harbor, MD. The goal of this summit is to advance practice of physical therapy by exploring the current status of different nations and emerging policies on direct access. CEUs will also be available.

Programming for the event includes symposiums on direct access policy and scope of practice, poster presentations, breakout discussions and working groups. This represents an opportunity to learn the latest research supporting these policy initiatives and share strategies for implementing policy at the local, regional or national level. Interested participants can register at www.directaccesssummit.com. What are your thoughts about the decision to hold this summit and what it can accomplish?